View of How do the Depression and Mental Health of Crew Members Create Threats to The Shipping Industry?

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Vol XIX. No. I (2022) pp 40–47 ISSN: 1697-4840, www.jmr.unican.es

How do the Depression and Mental Health of Crew Members Create Threats to The Shipping Industry?

Shabeeb AL-Balushi¹, Mehrdad Behforouzi^2,∗, Mohammed AL-Balushi³, Motasem AL-Mahrazi⁴, Zakaria AL-Alawi⁵

ARTICLE INFO ABSTRACT

Article history:

Received 11 Jan 2022;

in revised from 14 Jan 2022;

accepted 01 Feb 2022.

Keywords:

Depression, Mental health, life at sea, conduct, mariners well being.

Seafarers are facing a threat in their profession from the beginning, yet this threat is not being recog- nized or acknowledged as it should be by health organizations and seafarers. This threat is depression.

Research has shown seafarers have a highest risk of depression than any other major. This study aims to determine that depression and mental health problems are critical issues, and there is no precise treatment for these issues onboard. Based on a literature review, depression and cognitive problems are massive discomfort among seafarers. The authors surveyed seventy-five people by sending them eleven questions and interviewed five professionals. Analysis of the responses and interviewees demonstrated that depression and mental health disorders affect seafarers negatively, and they have little or no help onboard. The authors strongly recommend that mariners, shipping companies, and owners take depression and mental health disorders seriously and deal with them at their first stages.

1. Introduction.

Seafaring is an exciting and fantastic career. It will lead to jaw-dropping adventures that many would wish for, amazing views of the sea, and meeting new people, nationalities, and cultures. A seafarer could learn much more than their intended job. A seafarer must spend almost half the year or half of his life at sea without their family, hometown friends, and outdoor activities. Working onboard also is a physically and mentally demanding job. It takes a lot of dedication to become a seafarer.

Staying away from loved ones, working long hours without getting enough rest, and handling many responsibilities at once are

1Dept. of Maritime Studies, International Maritime College Oman, Oman, [email protected].

∗Corresponding author: Captain Mehrdad Behforouzi. E-mail Address:

[email protected].

everyday things for a seafarer. Still, it’s also a massive reason for depression.

What is depression, you may ask? According to Mayo Clinic (2018), ”it’s a mood disorder that causes a persistent sadness and loss of interest.” Scientifically speaking, it’s a significant issue, especially for the seafarer to get depressed. It will affect normal day-to-day activities, behaviour, and thinking, and sometimes it causes a depressed person to think that life is not worth living and may commit suicide. Disturbed sleep also can cause depression and mental issues, especially among seafarers, due to the nature of the workplace on board a ship. Various operations force mariners to stay awake and sharp to avoid ne- glect and misunderstanding between the vessel and the shore- side. This extra concentration will negatively affect the seafarer’s mental health, eventually displaying undesirable feelings in the depressed seafarer, Crew Health Advice (2019).

Mental health conditions may appear suddenly because of a specific event or incident. It is not easy to identify the reasons behind mental issues and depression. They are countless factors that will lead to depression and mental breakdown.

According to scientists, it’s not a weakness. It requires long-term treatment, such as medication and therapy (Mayo 2022).

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But onboard, there is no such thing as medication and treatment that a depressed seafarer desperately needs. For that, the ship may need to deviate from her original course to treat a seafarer, which is a considerable loss of time. In the shipping industry, time equals money. These illnesses are getting recog- nized more each day, especially among seafarers. Adventures and seeing amazing views are like a book cover for many hidden flawed pages, and the experience is to overcome all the hidden feelings and struggles and continue the job, which is a responsibility on seafarers’ shoulders. These issues are hard to solve because the ship is a small place unless it’s a happy place.

Showing the symptoms of depression is vital to avoid it, but onboard a ship, things are much more complicated because time is always against what a depressed person needs. The reduction of crew members every year also has a dark side, resulting in a lack of communication between the crew members. It means modern ship needs fewer people, and it gives less time to seafarers, making the interaction between seafarers and the outer world less.

2. Literature Review.

In this world of shipping, seafarers have the highest risk of affecting from depression (Editorial-team 2019). Unfortu- nately, this affects their mood, ability to work, and thinking.

International Maritime Charity Sailor Society and Yale Uni- versity studied more than a thousand seafarers. According to that study, twenty-six percentage of seafarers have shown symptoms of depression in just two weeks of working (Offshore 2018).

In 2014, World Health Organization (WHO) conducted a global study (WHO 2014), concerning one million people worldwide who die from suicide each year”. Most suicides are in low- income counties, where most seafarers belong. Dose depression is related to suicide. YES, because suicidal thoughts are one of the most severe depression symptoms.

Nichol (2017) theorizes all the reasons that will eventually lead to depression or mental breakdown are:

- The social isolation.

- Language barriers

- Reduction of crew members in recent years

- Separation from family and friends for an extended period

- Relationship breakdown - Obsessing with social media - Interfering with a period of rest - Financial worries

- Family problems

Some health conditions could worsen because of depression, such as diabetes, obesity, cancer, and asthma. Also, un- fortunately, there are some cases of harassment and bullying on board.

According to a Crew Mental Health article by David (2017),

”Harassment abuse and bullying is another serious matter both ashore and on board, but the defining thing about a ship is that there is no refuge from bullying.” Feeling down is one of the depression symptoms, but also feeling down is a part of life and is considered a case of depression.

According to (Higuera, 2021a), Major depression can cause various symptoms. For some, it may affect their body, and for others may affect their mood. Everyone will not experience the symptoms of depression in the same way. It depends on many factors, such as gender. Yes, depression can affect males and females differently.

Referring to the article written by Yang (2021), ”In the USA alone, twenty-one percentage of women and thirteen percentage of men experience major depressive episodes during their lifetime.”

Female symptoms are more severe than male depression symptoms (Saripalli, 2021a).

There are not many females in the shipping industry, and more often, there will be one or two females on board, which may cause loneliness and lead to mental issues.

Depression can be three types (Saripalli, 202b):

- Major depressive disorder - Persistent depressive disorder - Postpartum depression.

Major depressive disorder is a more severe depression type;

in this case, it will not go away quickly and requires immediate medication. Persistent depressive disorder happens when the symptoms stay the same for two years. Postpartum depression only happens to women after pregnancy. It affects every one out of nine mothers.

Throughout the literature, there is consistent evidence of depression and mental issues among seafarers. Shipping companies and seafarers are increasingly suffering from the causes of depression and cognitive problems. However, depression is a severe medical condition that worsens if not taken seriously.

According to an article published by UK Public and Indem- nity Club (P&I), companies are responding to the Captains and Chief Officers to help depressed seafarers (UKpandi, 2017).

Captains or Chief Officers can influence their mental health by encouraging and supporting crew members.

As stated by the P&I club (SteamshipMutual, 2020), the following factors adversely affect seafarers’ minds and keep them in a position of getting little support and help:

- Spending a long time away from families and loved ones.

- Demanding and harsh working environment.

- Ever-increasing levels of complexity in many operations.

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- Technology development and digitalization.

- Varieties of rules and regulations and compliance with them.

- Geo-politics.

Also, seafarers are under constant pressure from threats onboard, such as accidents, piracy, and illness. Living in these conditions will increase the intensifying fear and anxiety that will eventually lead to a panic attack. In response, the Mental Health Support Solutions and steamship mutual P&I club are providing help to those who are in need.

According to the UK P&I Club (UK Pandi, 2021a), a panic attack is a sudden surge of intense fear and discomfort that peaks within minutes. Do panic attacks relate to depression and mental health problems? The answer is yes because panic attacks are the same as depression symptoms. Panic attack symptoms include undesirable feelings such as fear of losing control, sweating, dizziness, abdominal distress, and discomfort. Panic attacks or panic disorders have many causes, such as anxiety, stressors, physical abuse, and smoking can be a cause of the panic attack.

Seafarers are most likely to get exposed to these causes because of the nature of the workplace, and they will probably quit their jobs to avoid such stressors that lead to panic attacks.

There are many treatments for panic attacks, but they mostly have the issue of producing mental health problems that can lead to depression.

Medications such as Xanax or Ativan and specific anti - depression treatments are all treatments to recover from a panic attack (UKPandi, 2021b). Still, these tablets may increase the chances of depression. So, the most effective treatment that can help with panic attacks and depression is Cognitive Behavioural Therapy (CBT).

CBT is the most used therapy to treat anxiety and depression, which can be helpful for other mental and physical health problems (Mental Health 2019).

Depression is a severe mental health illness with the poten- tial for complications (Healthline 2021).

There are numerous treatments for depression and mental health issues with fewer side effects. According to (Higuera 2021b), the following are beneficial medications that treat depression and mental health problems:

- Selective Serotonin Reuptake Inhibitors (SSRIs).

- Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).

- Tricyclic and tetracyclic antidepressants.

- Noradrenaline and Dopamine Reuptake Inhibitors (NDRIs).

- Mono Amine Oxidase Inhibitors (MAOIs).

- Electro Convulsive Therapy (ECT).

- Dialectical Behaviour Therapy (DBT).

- N-Methyl D-Aspartate (NMDA) antagonists.

But how can depression be detected or tested?

Depression and mental health symptoms are mostly silent, and no single test exists for depression.

Psychologists will determine if a person is suffering from depression by asking questions about their mood, appetite, sleep pattern, activity level, and thoughts (Holmes 2021).

On ships, however, there are no psychologists to determine if a seafarer is depressed or not. It depends on the crew members’ or captain’s ability to recognize the symptoms of depression and help them as soon as possible.

3. Methodology & Data Collection.

The methods to approach were mixed. This research requires both the qualitative and quantitative methods of approach to understanding depression among seafarers. The authors conducted an online survey via LinkedIn and interviews with seafarers and professionals such as port operators, superintendents, maritime graduates, and one doctor. The survey consisted of eleven closed-end questions. A total of seventy-five seafarers responded to the study. The respondents were mariners who either suffered from depression or witnessed such issues. The participants had a week to fill in the survey anonymously.

Not all seafarers have the luxury of internet onboard, so only seventy-five responded. Furthermore, the authors interviewed four mariners and one experienced doctor.

The authors asked the following questions from the seafarers:

1. What was the reason behind your depression?.

2. When did you realize you have depression?.

3. How long did it take to recover from the depression?.

4. How to avoid depression?.

The authors asked the following questions the doctor:

1. How long does it take to recover from depression?.

2. How to avoid depression?.

The limitations of this methodology:

- Humans are very good at hiding their feelings, so it could be challenging to get a straight answer or understand depression among seafarers.

- Only four seafarers came forward to conduct the inter- view.

- Although the authors had no plan to disclose the respondents’ identities, some seafarers were still worried about being identified.

- The authors aimed to get a response from hundred seafarers, but because of some difficulties, including network issues onboard, only seventy-five have replied.

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4. Results & Findings.

4.1. Survey results.

The results and conclusions are as shown below:

Figure 1: Positions/titles of respondents.

Source: Authors.

Figure one shows that forty percent of respondents who took the survey were officers, thirty-nine percent were captains, twelve percent were cadets, and seven percent were maritime graduates. Moreover, one percent of the participant was the port operator, and the remaining one percent was the superintendent.

Figure 2: Depression symptoms.

Source: Authors.

Figure two shows a high percentage of seventy-one percent of the total number of respondents who have experienced symptoms of depression. It highlights that depression among seafarers is an issue. Still, twenty-nine percent of respondents have never experienced any depression symptoms, which is good.

Still, seafarers who experienced symptoms are far greater than those who haven’t experienced depression.

Figure three shows that seventy percent of seafarers who have replied to the survey experienced and encountered a depressed crew member. Most crew members on board ships are keen to maintain good relationships and teamwork. Therefore, they can realize any depression symptoms among their friends.

Thirty percent of them had never experienced such a thing.

Figure 3: Depressed seafarer.

Source: Authors.

Figure 4: Depression issue onboard.

Source: Authors.

Figure four shows that seventy percent of seventy-five respondents selected yes to the survey’s primary purpose. This large number indicates how severe depression is in the shipping industry. Thirty percent of respondents don’t agree with this question.

Figure 5: Suicidal thoughts.

Source: Authors.

According to figure five, eighty-four percent of respondents believe depression can lead to suicidal thoughts. As shown in the previous chapter by the world health organization, six per-

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cent of all deaths worldwide are proven to be suicides by seafarers. On the other hand, sixty percent of the respondents denied such a thought.

Figure 6: Overworking leads to depression.

Source: Authors.

The respondents’ findings in this question came up with a different opinion, which defined forty-seven of the evaluation as Yes. The same percentage of the respondents answered that long working hours might lead to depression (figure 6). The remaining seven percent analysed that depression has no relationship with long working hours.

Figure 7: Ignoring depressed seafarer.

Source: Authors.

As indicated in figure seven, Sixty-three percent of the crew members answered no because laughing at a depressed person or a seafarer is being disrespectful, in their opinion. Still, thirty- seven percent of the respondents quite shockingly responded yes. This percentage outlines that many seafarers are unaware of their mental health, especially onboard ships.

Seventy-nine percent of respondents reported stress while working onboard a ship (Figure eight). Twenty-one percent of the respondents answered No.

Figure 8: Stress while working.

Source: Authors.

Figure 9: Cure for depression.

Source: Authors.

According to figure nine, sixty-eight percent of the respondents agreed facilities assist in curing depression on board a ship. Thirty-two percent believed there is no cure for depression on a vessel.

Figure 10: Organization for depression.

Source: Authors.

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Figure ten shows that sixty-seven percent of the respondents believe that organisations have such intentions towards helping and treating the depressed seafarer to overcome depression on board a ship. Thirty-three percent of the seafarers who did the survey dined about any treatment centres, which helped the seafarers overcome the depression.

Figure 11: Companies’ response to depression.

Source: Authors.

As indicated in figure eleven, fifty-five percent of the respondents agreed that the companies hold meetings to discuss depression. Still, forty-five percent of shipping companies need to be aware of these important meetings and their critical role in the health of mariners.

4.2. Interviews.

The authors conducted the interviews in person.

Interviewee 1: (12 May 2022/ in person)

He is a captain in a famous shipping company in Oman.

Question One: What was the reason behind your depression?

Answer: Because of the environment of the ship. The ship’s crew members were of different nationalities, and I was the only Omani. I did not even speak my mother language. I did not even talk with anyone in my free time. I was alone most of the time, which took a massive toll on my personality and behaviour.

Question Two: When did you realize you have depression?

Answer: I didn’t realize it at all. I was alone most of the time and barely talked with someone. Probably, it was what being a seafarer meant. I kept all the feelings to myself and didn’t tell anyone. I realized it when I went home and talked with my family and friends. “It is tough to spend months onboard without making friends.”

Question three: How long did it take to recover from the depression?

Answer: I do not recall it. However, I felt normal again when I went back home.

Question four: How to avoid depression?

Answer: Try to talk and make friends with anyone on board.

Even with a language barrier, speak to them, and don’t spend too much time alone in the cabin. It will affect your social life and build a strong relationship with the crew members.

Interviewee 2: (12 May 2022/ in person)

He is a superintendent in a famous shipping company in Oman.

Answer: I did not get signed off even after I terminated my contract and was still working on board the ship. I was tired and frustrated from working and just wanted to go home to my family. Finally, I lost interest in working, as staying onboard was like hell.

Answer: “I didn’t realize it until I recovered from it”. After going home, I realized how horrible the last months were onboard. I never wish to experience those symptoms ever again.

Answer: One week after signing off and went back home.

Answer: There will always be a time when you feel depressed. However, believe in yourself and avoid staying for an extended period on a ship. Do not overthink the future. Try to socialize with other crew members, especially in your free time.

Interviewee 3: (14 May 2022/ video call)

He is a Designated Person Ashore (DPA) in a famous shipping company in Oman.

Answer: Work stresses. When I was working as a ship captain, I had many responsibilities. I could not sleep at night or eat well and was always busy thinking about the ship’s busi- ness and safety. Eventually, I decided to quit sailing and started working as DPA.

Answer: ”When I couldn’t sleep at night and couldn’t eat my favourite food.” I became angry and even aggressive.

Answer: I started taking medication from a psychologist to control my anger. In general, it took more than three months for me to recover.

Answer: To seek help from a psychologist. Remember, anger will consume you if you do not control it.

Interviewee 4: (11 May 2022/ Telephone call) He is a Captain.

Answer: Family problem. My child was diagnosed with Multiple Sclerosis (MS), a disease affecting the central nervous system. With this condition, the family must take care of him,

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yet I was working onboard to support and provide money for the family and the treatment. I was always worried and thinking about my family, killing me from the inside.

Answer: I had unpleasant thoughts and feelings that I could not ignore as I was thinking of my family’s future. These thoughts and feelings are worse than physical pain. At least physical pain can be healed automatically but not mental pain.

Answer: I sometimes feel sad and hopeless at home with my family. I realized it was the depression that I was suffering from, but unable to do anything about it. I am taking medicines recommended by doctors to keep these feelings out of my mind.

The medication is working, but sadly, I worry that depression will eventually come back.

Answer: Visit a doctor and talk with them and let them cure mental pain. Talk to your friends about your feeling. Let- ting these feelings out will help you to clear your mind.

Interviewee 5: (18 May 2022/ Email)

She is a psychologist doctor in a clinic in Oman.

Question one: How long does it take to recover from depression?

Answer:Thirty percent of people with depression will get episodes of depression throughout their life. Also, it all depends on the willpower of that person. They might recover in two or three weeks or between three to six months.

Question two: How to avoid depression?

Answer: To make friends onboard because talking and let- ting these feelings out will help avoid depression, always think positively, and don’t let your emotions consume you. If there is no change, then seek help from a psychiatrist.

Conclusions and recommendations.

This study revealed that depression on board is a critical issue that shipping companies and crew agencies must deal with seriously. Thus, based on the authors’ research and findings, The following recommendations are now presented:

1- There should be responsible health organizations about mental health for seafarers, and they should teach or show how to address this problem and avoid it before it happens.

2- A review of working hours and ensuring adequate time for rest.

3- Improving occupational conditions by doing whatever possible to minimize accidents.

4- Providing a 24/7 free helpline for seafarers at sea and ashore.

5- To provide a psychologist for the family of seafarers.

6- To comply with Maritime Labour Convention (MLC) regulations and prevent seafarers from staying on board for more than four-five months.

7- Seafarers eat well and avoid stimulants such as nicotine and caffeine. Also, exercise, use relaxation techniques, medita- tion, and sleep well.

8- Ensure seafarers have continuous access (telephone/ internet) to their families and loved ones.

9- Ensure seafarers are well paid and can make a good life with enough facilities for family and themselves. It avoids seafarers constantly worrying about their future and comparing themselves with those working ashore.

10- To conduct training classes for seafarers, especially Cap- tain and the senior officers, showing them how to deal with stress and keep the crew happy onboard.

11- Focus on the diet because healthy food equals a healthy mind.

12- Regular exercise, exercising will keep the mind fresh.

13- Encouraging seafarers to talk about their mental health and well-being brings normality to the issue.

14- Captain and senior officers shall discuss the importance of mental health routinely in the office and safety meetings onboard.

15- Financial support from the companies to treat the depressed seafarers.

16- Crew members should spend time with depressed seafarers. If they want to be alone, leave them but remind them that you are there for help.

17- If you get stressed from work, take steps to control the stress and boost your self-esteem.

18- Don’t ignore the depression symptoms and get help at the earliest depression signs.

19- Shipping companies must increase their focus on the seafarer’s mental health.

20- World Health Organization (WHO) should raise aware- ness of mental health and well-being at sea.

21- To conduct further research about depression and mental health, its connection to the working environment on board, and its effect on future generations.

Acknowledgements.

The authors gratefully acknowledge the support received from the International Maritime College Oman for this research.

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